ZOOMit IVIM成像评估子宫内膜癌病理分级及Ki-67表达的价值  

Value of ZOOMit IVIM imaging in endometrial carcinoma for estimating histological grade and Ki-67 expression

作　　者：王芳 刘颖 张宇威 马娟微 叶兆祥 WANG Fang;LIU Ying;ZHANG Yu-wei(Department of Radiology,Tianjin Medical University Cancer Institute&Hospital,Tianjin 300060,China)

机构地区：[1]天津医科大学肿瘤医院放射科国家肿瘤临床医学研究中心,天津市“肿瘤防治”重点实验室天津市恶性肿瘤临床医学研究中心,天津600060 [2]徐州市妇幼保健院放射科,徐州221009

出　　处：《放射学实践》2022年第3期356-362,共7页Radiologic Practice

摘　　要：目的:探讨基于缩放成像技术的体素内不相干运动成像(ZOOMit IVIM)在术前评估子宫内膜癌病理分级及Ki-67表达中的价值。方法:前瞻性纳入65例术前两周内接受盆腔ZOOMit IVIM检查的子宫内膜样癌患者,其中25例患者同时行SS-EPI IVIM检查。分析ZOOMit IVIM与SS-EPI IVIM成像在图像质量及定量参数测量方面的差异;测量基于ZOOMit成像肿瘤的表观扩散系数(ADC)值、真扩散系数D值、伪扩散系数D^(*)值及灌注分数f值,分析各参数值与子宫内膜癌病理分级、Ki-67表达指数之间的相关性;对于子宫内膜癌不同病理分级与Ki-67表达组间差异有统计学意义的参数,采用受试者操作特征曲线(ROC)评价其对病理高级别组(G3级)及Ki-67高表达组的鉴别诊断效能。结果:ZOOMit IVIM图像在几何失真、解剖细节、伪影主观评分及信噪比、对比信噪比客观评价方面均优于SS-EPI IVIM,组间差异有统计学意义。基于两组图像测量的定量参数值组间差异无统计学意义,但基于ZOOMit成像两名医师测量结果的组间一致性更高(ICC_(ZOOMit)=0.957,95%CI 0.899~0.981;ICC_(SS-EPI)=0.890,95%CI 0.750~0.952)。ZOOMit IVIM定量参数ADC值、D值与病理分级、Ki-67表达指数呈负相关,D^(*)值与病理分级呈负相关,f值与病理分级、Ki-67表达无明显相关性。鉴别诊断G3级子宫内膜癌,ADC值、D值和D^(*)值的AUC值分别为0.711、0.763、0.679,其中D与D^(*)值联合的AUC值为0.817。鉴别子宫内膜癌Ki-67高表达组,ADC值、D值的AUC值分别为0.698、0.720。结论:ZOOMit技术在子宫内膜癌IVIM序列检查中具有较好可行性,ZOOMit IVIM成像在术前评估子宫内膜癌病理分级及Ki-67表达中具有一定参考价值。Objective:To explore the value of ZOOMit IVIM imaging in preoperatively estimating pathological grade and Ki-67 expression level of endometrial carcinoma.Methods:65 patients with endometrioid carcinoma were prospectively enrolled,who had received ZOOMit IVIM pelvic MR examination within 2 weeks before surgery,and of which 25 patients were examined by SS-EPI IVIM at the same time.The differences of ZOOMit IVIM and SS-EPI IVIM in image quality and quantitative parameter measurement were analyzed.The apparent diffusion coefficient(ADC)value,true diffusion coefficient(D)value,pseudo-diffusion coefficient(D^(*))value and perfusion fraction(f)value of lesion based on ZOOMit IVIM imaging were measured.The correlation between each parameter with pathological grade and Ki-67 expression index was analyzed.The differences of the parameters among different pathological grades and Ki-67 expression index were compared.ROC curve was used to determine diagnostic efficiency.Results:ZOOMit IVIM image was superior to SS-EPI IVIM image in geometric distortion,anatomical details,artifact,SNR and CNR,and there were statistical differences in the qualitative score and the quantitative measurement between the two sets of images.There was no statistically significant difference in the quantitative parameter measurements between the two groups,but there was a higher consistency based on ZOOMit IVIM imaging(ICC_(ZOOMit)=0.957,95%CI 0.899~0.981,ICC_(SS-EPI)=0.890,95%CI 0.750~0.952);ZOOMit IVIM quantitative parameters ADC and D values were negatively correlated with tumor grades and Ki-67 expression levels,and there were statistical differences among different pathological grades and Ki-67 expression statuses.The AUC values of the ADC value,D value,D^(*) value for differential diagnosis of the high grade were 0.711,0.763,and 0.679 respectively,the AUC value of combined D and D^(*) value was 0.817.The AUC values of the ADC,D value for antidiastole of the high Ki-67 expression were 0.698 and 0.720 respectively.There were no significant correla

关 键 词：子宫内膜肿瘤 体素内不相干运动 病理分级 KI-67表达 

分 类 号：R445.2[医药卫生—影像医学与核医学] R737.33[医药卫生—诊断学]